How to Obtain Prior Authorization Clause Samples

The "How to Obtain Prior Authorization" clause outlines the process that must be followed to secure approval before certain actions or expenses are undertaken. Typically, this clause details the steps required to request authorization, such as submitting documentation or forms to a designated authority, and may specify timelines or required information. Its core practical function is to ensure that all necessary permissions are obtained in advance, thereby preventing unauthorized actions and helping to control costs or manage risk within the agreement.
How to Obtain Prior Authorization. To obtain prior authorization or to confirm that a network provider has obtained prior authorization, contact us by telephone at the telephone number listed on your health insurance identification card before the service or supply is provided to the member. Failure to comply with the prior authorization requirements will result in benefits being reduced. Network providers cannot bill you for services for which they fail to obtain prior authorization as required. Benefits will not be reduced for failure to comply with prior authorization requirements prior to an emergency. However, you must contact us as soon as reasonably possible after the emergency occurs.
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How to Obtain Prior Authorization. To obtain prior authorization or to confirm that a network provider has obtained prior authorization, contact us by telephone at the telephone number listed on your member identification card before the service or supply is provided to the member. Failure to comply with the prior authorization requirements will result in benefits being reduced. There is a penalty if treatment is not authorized prior to service. The penalty is a 20 percent reduction of the eligible expenses for all charges related to the treatment, not to exceed $1,000. The penalty applies to all otherwise eligible expenses that are:
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Related to How to Obtain Prior Authorization

  • Prior Authorization A determination to authorize a Provider’s request, pursuant to services covered in the MississippiCAN Program, to provide a service or course of treatment of a specific duration and scope to a Member prior to the initiation or continuation of the service.

  • Power; Authorization Such Investor has all requisite power and authority to execute and deliver this Agreement. This Agreement, when executed and delivered by such Investor, will constitute a valid and legally binding obligation of such Investor, enforceable in accordance with its respective terms, except as: (a) limited by applicable bankruptcy, insolvency, reorganization, moratorium and other laws of general application affecting enforcement of creditors’ rights generally; and (b) limited by laws relating to the availability of specific performance, injunctive relief or other equitable remedies.

  • Governmental Authorizations; Private Authorizations; Governmental Filings It has obtained, maintained and kept in full force and effect all material Governmental Authorizations and material Private Authorizations which are necessary for it to properly carry out its business, and made all material Governmental Filings necessary for the execution and delivery by it of the Facility Documents to which it is a party and the performance by it of its obligations under this Agreement and the other Facility Documents to which it is a party.

  • Authorizations and Consents No authorization, consent, approval, exemption, franchise, permit or license of, or filing with, any governmental or public authority or any third party is required to authorize, or is otherwise required in connection with the valid execution and delivery by the Borrower of this Agreement, the Notes, and the Security Instruments, or any other instrument contemplated hereby, the repayment by the Borrower of advances against the Notes and interest and fees provided in the Notes and this Agreement, or the performance by the Borrower of its obligations under any of the foregoing.

  • Network Authorization For services that cannot be provided by a network provider, you can request a network authorization to seek services from a non-network provider. With an approved network authorization, the network benefit level will apply to the authorized covered healthcare service. If we approve a network authorization for you to receive services from a non- network provider, our reimbursement will be based on the lesser of our allowance, the non-network provider’s charge, or the benefit limit. For more information, please see the How Non-Network Providers Are Paid section.